Travere and KDIGO Podcast Collaboration

Conversations in Nephrology: Challenges of Implementing Evidence-Based Guidance for IgA Nephropathy

Episode Summary

In this Travere-sponsored episode of KDIGO Conversations in Nephrology, Dr. Dana Rizk engages Dr. Suneel Udani in a discussion on the practical challenges of implementing the updated KDIGO IgA Nephropathy Guideline in clinical practice. Within an expanding treatment landscape, clinicians must navigate lower proteinuria targets, earlier biopsy thresholds, and a shift toward simultaneous multi-targeted therapy.

Dr. Udani discusses barriers to guideline adoption, including awareness gaps, prior complacency in management, and natural anxiety around adopting new therapies. The conversation also examines key lessons from recent clinical trials — particularly the validation of proteinuria reduction as a surrogate endpoint and the sobering rate of estimated glomerular filtration rate (eGFR) decline observed in control groups. Importantly, this episode explores strategies to accelerate implementation, including peer engagement, identifying local centers of expertise, and advancing patient education, while also highlighting current knowledge and evidence gaps that will shape the next phase of IgAnephropathy care.

Dr. Suneel Udani, M.D. – Nephrology Associates of Northern Illinois and Indiana, Hinsdale, IL

Dr. Dana Rizk, MD (host) – University of Alabama at Birmingham, Birmingham, AL

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Key Takeaways

“There’s definitely always a lag between [guidelines] being published and then global awareness, especially in the community nephrology space.” (1:30)

“The idea of simultaneous therapy, of multiple targets, treating renal protection with our conventional agents… while also treating the immune and inflammatory nature of IgA nephropathy — this is a very different concept than what was previously outlined, and I think disseminating this information is going to be the first key.” (2:15)

“There are knowledge gaps, there are implementation challenges, but undoubtedly this is an exciting time for IgA nephropathy […] We need to embrace the knowledge that we’ve learned, the success of these new therapies that have demonstrated efficacy, tolerability, safety, as well as a more insightful paradigm.” (16:25)

Adoption of the updated KDIGO IgA Nephropathy Guideline requires increased awareness of specific changes including earlier biopsy thresholds and lower proteinuria targets
Simultaneous treatment of kidney-protective pathways and immune drivers represents a meaningful paradigm shift in IgA nephropathy care
Clinical trials have supported proteinuria reduction as a surrogate endpoint, demonstrated reduction in proteinuria and preservation of kidney function, and highlighted the substantial eGFR decline in patients without intervention, reinforcing the severe natural history of IgA nephropathy
Knowledge gaps remain in optimal therapy selection, treatment duration, underrepresented populations (such as pediatric patients and those with secondary forms of IgAN), post-transplant recurrence, and non-invasive markers of treatment response
Education, local peer engagement, and patient education are critical drivers of real-world implementation of the KDIGO IgA Nephropathy Guideline in clinical practice

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Disclaimer: This episode of Conversations in Nephrology was supported by Travere Therapeutics and developed by Kidney Disease: Improving Global Outcomes. The opinions presented are those of the individual speakers and not those of Travere Therapeutics. This podcast episode was published on December 18, 2025. Please always consult updated sources for the latest information, as information discussed may have changed since the recording date.

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